150. Cerebral hemorrhage: classification, causes, pathological anatomy, complications, outcomes, clinical significance.

Cerebral hemorrhage is damage to the parenchyma of the brain caused by bleeding due to rupture of the intracerebral artery, leading to compression and displacement of supra- and subtentorial structures.

Etiology:

-Arterial hypertension

-Malformations of the arterial system of the brain — aneurysms, angiomas,

- Coagulopathy

-Hemorrhage into the tumor

-Hemorrhagic transformation of a heart attack

- Injuries

- Vasculitis

Types: Epidural hematoma - blood accumulates between the bones of the cranial vault and the meninges, i.e. in the epidural space. The source is the middle shell a or its branches Subdural hematoma - blood is poured out between the inner meninges outside and the arachnoid inside Subarachnoid hematoma - between the arachnoid and soft meninges Intracerebral - bleeding from the vessels of the brain tissue Intraventricular hematoma - accumulation of blood in the ventricles GM

They are also classified into: petechiae, hematomas, hemorrhagic infiltrations.

Complications:

Loss or speech disorders.

Changes in behavior, emotional component.

Problems in the work of the senses.

Cognitive deviations. Thinking, memory, perception, and concentration suffer.

Disability.

Deep vegetative state.

Death.

151. Ischemic cerebral infarction: causes, pathological anatomy, complications, outcomes, clinical significance.

Ischemic stroke is the formation of foci of necrosis in the GM as a result of metabolic disorders caused by insufficient blood supply; acute cerebrovascular accident with damage to brain tissue, damage to its functions or cessation of blood flow. It is accompanied by softening of areas of brain tissue - a cerebral infarction

Classification

1. By type

- White (ischemic) - occurs in conditions of insufficient collateral circulation

- Red (hemorrhagic) - occurs in conditions of a double type of blood supply to the tissue

- Mixed

2. By size

- Extensive, Large, Medium, Small Deep

3. By localization

- Superficial, Deep

Etiology

- CHD and blood vessels

- High blood viscosity

- The act of rheumatic endocarditis

- IBS

- Myocardial infarction

- Age over 60

- Alcoholism, smoking

- Coagulopathy

- SD

The form of AI development

1- Acute - symptoms increase within a few minutes

2- Subacute - symptoms increase within a few hours /days

3- Chronic - the course is gradual - the symptoms increase for 1 or more months

4 - Intermittent - symptoms increase gradually over 2-3 weeks, with short intervals between each deterioration

Morphological changes in transient ischemic attack of the brain are manifested by vascular disorders (spasm of arterioles, plasma leakage of their walls, perivascular edema and single small hemorrhages), as well as the appearance of foci of altered brain tissue (edema, dystrophic changes in cell groups). These changes are reversible.

Ischemic heart attack is the most common manifestation (75% of cases) of ischemic stroke. It looks like a focus of gray softening of brain tissue. During microscopic examination, dead neurons are found among the necrotized masses.

Hemorrhagic cerebral infarction looks similar to the focus of hemorrhagic stroke, but has a different mechanism of occurrence. Ischemia of the brain occurs primarily; hemorrhage into ischemic tissue occurs secondarily. Hemorrhagic infarction is more common in the cerebral cortex, less often in the subcortical nodes.

With a mixed infarction, which always occurs in the gray matter of the brain, it is possible to find areas of both ischemic and hemorrhagic infarction.